Claim specialist vs senior claims examiner

The differences between claim specialists and senior claims examiners can be seen in a few details. Each job has different responsibilities and duties. It typically takes 4-6 years to become both a claim specialist and a senior claims examiner. Additionally, a senior claims examiner has an average salary of $50,962, which is higher than the $43,164 average annual salary of a claim specialist.

The top three skills for a claim specialist include customer service, litigation and patients. The most important skills for a senior claims examiner are customer service, litigation, and property damage.

Claim specialist vs senior claims examiner overview

	Claim Specialist	Senior Claims Examiner
Yearly salary	$43,164	$50,962
Hourly rate	$20.75	$24.50
Growth rate	-6%	-6%
Number of jobs	29,505	10,931
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 54%	Bachelor's Degree, 58%
Average age	44	44
Years of experience	6	6

What does a claim specialist do?

A claims specialist is responsible for processing insurance claims, reviewing insurance coverage, and analyzing claims cases. Claims specialists' duties include negotiating claims settlements, validating claims to prevent fraud, creating court testimonies as needed, developing claim review plans, and checking necessary documents and related resolve claims. A claims specialist must have strong analytical and critical-thinking skills to authorize claim payment and investigate complex and unusual claims. Claims specialists should also have extensive knowledge of the insurance processes to handle various cases, following legal policies and regulatory procedures.

What does a senior claims examiner do?

Senior claims examiners review, assess, and process the insurance claims of their clients. The examiners provide recommendations for claims-related resolution. It is their responsibility to examine and authorize the investigation of insurance claims as conducted by insurance adjusters. They check the claims and the insurance policies to ensure that all the information is right. During the settlement, they are expected to be careful in keeping the records with details of the process.

Claim specialist vs senior claims examiner salary

Claim specialists and senior claims examiners have different pay scales, as shown below.

	Claim Specialist	Senior Claims Examiner
Average salary	$43,164	$50,962
Salary range	Between $27,000 And $67,000	Between $34,000 And $75,000
Highest paying City	Newark, NJ	Urban Honolulu, HI
Highest paying state	New Jersey	Hawaii
Best paying company	W. R. Berkley	W. R. Berkley
Best paying industry	Insurance	Finance

Differences between claim specialist and senior claims examiner education

There are a few differences between a claim specialist and a senior claims examiner in terms of educational background:

	Claim Specialist	Senior Claims Examiner
Most common degree	Bachelor's Degree, 54%	Bachelor's Degree, 58%
Most common major	Business	Business
Most common college	Stanford University	Stanford University

Claim specialist vs senior claims examiner demographics

Here are the differences between claim specialists' and senior claims examiners' demographics:

	Claim Specialist	Senior Claims Examiner
Average age	44	44
Gender ratio	Male, 31.0% Female, 69.0%	Male, 29.6% Female, 70.4%
Race ratio	Black or African American, 11.4% Unknown, 4.4% Hispanic or Latino, 16.5% Asian, 5.1% White, 62.1% American Indian and Alaska Native, 0.5%	Black or African American, 10.8% Unknown, 4.4% Hispanic or Latino, 16.8% Asian, 5.2% White, 62.3% American Indian and Alaska Native, 0.5%
LGBT Percentage	10%	10%

Differences between claim specialist and senior claims examiner duties and responsibilities

Claim specialist example responsibilities.

Assist in the streamlining of EDI process to manage workflow of EDI claims.
Manage claims on desk, route/queues, and ECHS within specify turn-around-time parameters.
Manage claims, route/queues, and ECHS, within specify turn- around time parameters.
Investigate, manage, negotiate and resolve claims arising out of accidents involving automobile and homeowner policies.
Upgrade CPT-4 and ICD-9 coding procedures, staying in step with many manage care plans changing reimbursement schedules.
Manage expedition of appeals via problem solving and collaboration with other departments.

Senior claims examiner example responsibilities.

Manage day-to-day operations of claims department and provide general oversight and direction of all claims activity.
Coordinate vendor referrals for additional investigation and/or litigation management
Maintain office records of various types of complaints, conciliation, administrative decision, private litigation resolution, gather detailed information.
Ensure all HIPPA regulations are followed in the creation and release of all confidential records.
Coordinate vendor referrals for additional investigation and/or litigation management

Claim specialist vs senior claims examiner skills

Common claim specialist skills

Customer Service, 19%
Litigation, 7%
Patients, 5%
Claims Handling, 4%
Quality Standards, 4%
Excellent Organizational, 4%

Common senior claims examiner skills

Customer Service, 21%
Litigation, 11%
Property Damage, 9%
Claims Handling, 6%
TPA, 4%
Coverage Issues, 4%

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Claim Specialist vs Senior Claims Examiner

Updated January 8, 2025

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